Study: If Americans better understood the Affordable Care Act, they would like it more

When it comes to people’s understanding and view of the Affordable Care Act, confusion and mixed feelings seem to reign. But if education efforts were to correct public misunderstanding of the law, would Americans think more favorably it? According to Stanford social psychologist Jon Krosnick, PhD, and colleagues at GfK, the Associated Press and elsewhere, the answer appears to be yes.

In a paper (.pdf) released just in time for the upcoming presidential election, the researchers used data from two national surveys, one conducted in 2010 and one in 2012, to first explore Americans’ understanding of the law. Survey participants had been asked, among other things, 18 questions about whether a certain provision was in the bill passed by Congress, and while often-large majorities gave correct answers regarding many provisions, 0 percent answered all questions correctly.

“No Americans correctly understood what is and is not in the ACA,” Krosnick said. “Many people did not know that [certain] elements of the bill are included in it. And many people believed that the bill included elements (e.g. so-called “death panels”) that are not actually in the ACA.”

The researchers probed further to find that the majority of participants favored most of the elements of the health law that the researchers looked at; in fact, only three plan elements were not favored by the majority. The majority of participants also opposed policies that were sometimes erroneously thought to be part of the law – fewer than 20 percent, for example, supported “death panels.” In addition, the results show that the more accurate a person’s beliefs were about the 18 elements that the researchers asked about, the more he or she liked the law.

“We can infer that if people were to learn fully what the ACA includes, public approval of the bill would increase,” said Krosnick.

Krosnick and his colleagues next tested this idea by running a statistical simulation to predict whether people would favor or oppose the bill if they were to answer all of the quiz questions correctly. The results? The proportion of Americans who favor the bill would increase from the current level of 32 percent to 70 percent.

So what does this all mean? Noting that public understanding of the law hasn’t notably changed between 2010 and 2012, Krosnick said:

All this suggests that if the president had done a better job of educating the public about the bill years ago, public support for it would likely have been considerably higher. And this could still happen – if the public were to gain a better understanding of the bill in the coming months, they would like it a lot more.

And he labels this area a missed opportunity for President Obama:

If the public were better informed and more supportive of the bill, he could easily point to it as a victory of his first term, and that would likely boost his approval ratings and his chances for re-election. By missing this opportunity, Mr. Obama is likely to be suffering politically at the moment, and the potential that the bill may be repealed in the future is also now greater than it would [otherwise] be.